May a Cohen Go to the Dentist?

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This article was originally published in Yated Neeman.

Yankel Katz (*Names are fictitious) called me recently with a very surprising shaylah:

“I am scheduled to have a dental implant placed in my mouth.
My dentist told me that the procedure may require the insertion of cadaver bone
around the implant. Since I am a cohen, I
immediately realized that I may have a serious halacha problem on my hands, or
more accurately, in his hands and my mouth. May I have these products inserted?
May I even go into the dentist’s office knowing he has these remains (parts of
a corpse) on hand? Maybe I cannot even enter the building?”

I admit that I was more than a bit incredulous that human
remains are commonly used today in basic dentistry and medicine. I did some
research and discovered that indeed, Yankel’s information is accurate. Many
forms of dental, oral, podiatric and other kinds of surgery utilize cadaver
derived products. Surgeons and dentists use these human products (typically
bone, skin, and heart muscle) in various grafting procedures. Similarly, many
podiatrists use human remains in the construction of foot implants. Because of
this, most periodontists (gum specialists) and
dentists specializing in implants store human muscle and bone in their offices.
Thus, Yankel’s shaylah is realistic:
May a cohen enter an office building
knowing that there is probably a dental or foot clinic somewhere in the
building that contains human remains? Does this prohibit a cohen from freely entering large office buildings? Furthermore, a
non-cohen who causes a cohen to become tamei will also be violating
the Torah. Obviously, the ramifications of these shaylos are ominous, and the potential repercussions could be
catastrophic for people employed in most cities. Because of these
considerations, I researched this shaylah
with utmost seriousness.

There are three potential halacha issues involved in this shaylah:

I. Benefiting From Human Remains (Issur Hana’ah)

II. The Mitzvah of Burial

III. Tumah.

To answer these questions, I first needed to gather some
factual information. I began by asking Yankel’s dentist the following
questions:

1) How extensively are these bones
and muscle used?

2) How much material does a
dentist keep in his office?

I received the following answers:

1) Every periodontist and oral
surgeon has this material in his office. In addition, many general dentists
have it too if they perform gum surgery or implant surgery.

2) There is no practical way to answer
this question accurately. Specialists such as oral surgeons probably have a
lot. I keep between 2-10cc. They are usually stored in 0.5, 1, and 2cc bottles.

And now some background to the
halachic shaylos involved:

I. BENEFITING FROM A CORPSE

May one benefit from a corpse or
from human remains?

The Gemara rules that one may not benefit from a corpse (Avodah Zarah 29b). However, the Gemara
does not discuss whether this prohibition applies only to the remains of a Jew
or also to those of a non-Jew.

Why should it make a difference?

The Torah pasuk
teaching that one may not benefit from a corpse refers to a Jew. Thus, many poskim conclude that the prohibition is
restricted to the remains of a Jew (Tosafos
and Rashba, Bava Kamma
10a; Nekudos
HaKesef
and Gra, Yoreh Deah 349; Shu’t Radbaz #741; Mishneh LaMelech, Hilchos Aveil 14:21). Others rule that remains of
either Jews or non-Jews are equally forbidden (Shu’t Rashba 365; Shulchan
Aruch
, Yoreh Deah 349:1). Still
others compromise between these two positions, contending that the prohibition
to use a gentile cadaver is Rabbinic, whereas not using a Jewish corpse is
prohibited min haTorah (Pischei Teshuvah ad loc.).

In a circumstance of pikuach
nefesh
one may of course benefit, as is true with virtually all mitzvos of
the Torah. The question is that tooth replacement is not a case of life
threatening urgency. However, it may be very important to allow the patient to
use the best quality dental implant.

To quote Yankel’s dentist, himself an observant Jew:

“In my opinion, the severity of this
halachic issue should hinge on the detriment caused by tooth loss. Clearly
losing one tooth or even all the teeth will not result in death. However, tooth
loss often results in dietary/nutritional issues. People who have a difficult
time chewing will not have a proper diet. Although people who lose their teeth
can still eat, they tend to eat soft foods, which are usually high in
carbohydrates and low in protein, vitamins, and minerals. Foods that are high
in protein, vitamins, and minerals, such as meat, poultry, grains, and fresh
fruits and vegetables, tend to be harder to chew. Consequently, people who eat
mainly soft foods may become undernourished. I have seen many cases where
people receiving their first set of dentures lose a lot of weight due to the
difficulty involved in learning how to use them. Some people adapt and those who
do not often seek implants if they can afford it. The only thing preventing
most people from having implants is the exorbitant cost, since insurance does
not usually pay for them at this time.”

At this point, I think it is important to explain the
difference between dentures and implants. (I admit that I was unaware what
implants are until I was asked this shaylah.)

DENTURES VERSUS IMPLANTS

Dentures are removable appliances that replace some or all
of the teeth. They are usually not firm enough to allow a proper bite and chew,
and thus a patient using dentures usually regains only a very partial ability
to chew. In addition, they are often uncomfortable.

To install dental implants, the
dentist utilizes a surgical screw to which he cements crowns or bridges.
Alternatively, he uses the implants as anchors to hold complete dentures in
place. In either instance, the resultant bite is much stronger than dentures
and allows the patient an almost total ability to chew a regular diet.

Dental researchers introduced implants in the ‘60’s, and
they became mainstream practice in the ‘90’s. The last few years have seen a
huge surge in patient awareness and acceptance of the use of implants. Most
people consider them the “standard of care” for tooth replacement.

Therefore one can understand the practical importance of
using high-quality implants, assuming, of course, that no compromise of halacha
results for either the patient, the dentist, or other cohanim in the vicinity.

USE OF HUMAN TISSUE

Rav Moshe Feinstein wrote a teshuvah concerning transplanting human remains in non- lif e-threatening situations (Shu’t Igros Moshe, Yoreh Deah 1:229, 230). Clearly, one may
transplant such organs as kidneys, livers, and heart because of pikuach nefashos ( lif e-threatening
emergency). However, transplanting items such as bone, cornea, muscle, and
ligament are not usually for lif e-threatening
situations. As explained above, dental implants relieve a non- lif e-threatening emergency, although one could argue
that these situations are considered choleh
kol gufo
, where halachic rules are somewhat relaxed. Nevertheless, treating
a choleh kol gufo does not permit
violating a Torah prohibition.

We noted above that there is a dispute whether one may use
remains of a non-Jew; Rav Moshe concludes that under extenuating circumstances
one may rely on the lenient opinions. A second question now presents itself,
which is whether one may assume that the remains used are those of a non-Jew,
since using remains of a Jew is certainly prohibited min haTorah. Again, here also Rav Moshe ruled leniently that one
may assume that the remains are of non-Jewish source, since most people are not
Jewish (Mishneh LaMelech, Hil. Aveil 3:1).

NOT THE NORMAL
USE

Some poskim permit
the use of human remains for non-life-threatening emergencies because of a
different line of reasoning. The Gemara (Pesachim
25b) rules that someone who is ill, but does not have a life threatening
condition, may apply a balm made from arlah
fruit (that grow in the first three years of a tree’s growth),
notwithstanding that the Torah prohibits benefiting from such fruit.

Why is this permitted where the situation is not life
threatening?

This is because many prohibitions that are asur b’hana’ah (forbidden to benefit from),
are prohibited min hatorah only
when the prohibited item is used in its normal way. Smearing fruit on one’s
skin is not a typical, normal use. Since arlah is prohibited min
haTorah b’hana’ah
only when used in its normal way, smearing arlah fruit
as a balm involves only a rabbinic prohibition, which is relaxed for an ill
person.

However, this leniency does not apply to all prohibitions. For
example, the Torah prohibits using kilayim (that is, those of a
grapevine) min haTorah even in an atypical way. For this reason, an ill
person may not smear kilayim as a
balm, even though he may smear arlah
balm.

Where does the prohibition to use human remains fall? Is it
like arlah, and is permitted for an ill person to use in an atypical
manner, or like kilayim and prohibited.

The poskim dispute
whether the prohibition not to use human remains applies to using them in an
atypical way, Shu’t Radbaz #979 and Mishneh
L’Melech, Hilchos Aveil
14:21 are lenient, whereas Rabbi Akiva Eiger (notes
to Yoreh Deah 349) prohibits. If it is permitted, then there would be a
basis to permit the use of human remains from a Jew for someone who is ill, but
not life threatening. Rav Moshe rules that min
hatorah
one may not use human remains in an atypical way, although other poskim are lenient (Shu’t Har Tzvi,
Yoreh Deah
#277). Following the latter approach might allow using muscle
and bone even from a Jewish cadaver for implants.

However, since there are alternative sources for implants, such
as bovine tissue, it is halachically unclear whether this justifies use of
human implants when one can use non-human sources. Although some dentists feel
that the cadaver-based material is superior, others do not agree. Therefore,
someone who is considering cadaver implants should ask a shaylah from his or her Rav, whether or not one is a cohen.
In addition, although the dentist may have asked a shaylah and been told that he or she may use human implants, the
patient’s Rav may feel otherwise. Thus I believe that a frum dentist who received a psak that he must use human
tissue should advise his frum patients to ask their own shaylah.

II. THE REQUIREMENT TO BURY THE
DEAD

Is one required to bury a small amount of human remains?

The poskim dispute
how small an amount of Jewish remains requires the mitzvah of burying. Some
contend that one must bury even an amount as small as a k’zayis (Tosafos Yom Tov
to Shabbos 10:5). Others contend that
one is required to bury only that which could represent an entire body (Mishneh LaMelech, Hilchos Aveil 14:21). However, it seems that all agree that there
is no Torah mitzvah to bury the remains of a gentile, except due to tumah concerns. Thus, this question
would not affect our shaylah once we
assume that the remains involved are of a non-Jew.

III. TUMAH AND A COHEN

A human cadaver (meis)
of either Jew or gentile conveys
tumah when a person touches remains
or carries them. Although these halachos do not affect most Jews nowadays, a cohen is still forbidden to come in
contact with human remains in a way that he will become tamei.

Jewish remains convey tumah
through ohel, which means that a cohen may not be under the same roof or
in the same room as the remains. However, if all the doors and windows in the
room holding the remains are closed, the tumas
ohel
is probably contained within that room (see Nekudos HaKesef on Taz, Yoreh Deah 371:3; see also Shu’t Noda BiYehudah, Yoreh Deah #94).
However, there is a lesser form of tumah,
called sof tumah latzeis (lit., the tumah will eventually leave), that
extends beyond the closed doors or windows, though only in the direction that
one will eventually remove the tumah.

OHEL AND A NON-JEW

The poskim dispute
whether non-Jewish remains convey tumah
through ohel; that means, will
someone who is in the same room as non-Jewish remains become tamei? According to those who contend that non-Jewish remains convey tumas ohel, a cohen may not enter a room containing a gentile corpse or part of a
corpse. Thus, a cohen should be
careful not to enter any hospital except for a life-threatening emergency, since
there is likely to be human remains somewhere in the hospital. Similarly, a cohen may not enter a museum without carefully
verifying that it does not contain any human remains — an unusual
circumstance. According to those who contend that non-Jewish remains do not
convey tumas ohel, a cohen may enter a hospital when one may
assume that it contains no Jewish remains.

The Shulchan Aruch
rules that non-Jewish remains do not convey tumas
ohel
, yet a cohen should still be
machmir not to be in the same ohel
as gentile remains. Thus, a cohen
should not visit someone in the hospital unless there is an extenuating reason,
i.e., there is something important that only he may accomplish. Similarly, a cohen
should not enter a museum without verifying that it does not contain human
remains. [This discussion is limited to a case where the remains in the
hospital are of a non-Jew. In a situation where there are likely to be Jewish
remains in the hospital, a cohen would
be allowed to enter the hospital only for a life-threatening emergency (pikuach nefashos).]

Thus, if we assume that the remains contained in the dental
office are a non-Jew’s, then a cohen
entering the office would not entail a halachic violation, but would be something
that should be avoided (according to the above ruling of the Shulchan Aruch).
However because of other halachic factors (too complicated to explain in this
article), there is a basis to be lenient and enter the dentist’s office and
certainly the building. Personally, I would encourage the dentist to store the
remains in a way that guarantees that there is no tumas ohel, a procedure that
I will gladly explain to any dentist on an individual basis, but that is too
complicated to elucidate in this article.

WHAT ABOUT YANKEL KATZ’S
IMPLANT?

So far we have discussed whether one may use human remains
as an implant and whether a cohen may
enter the office. Assuming that Yankel’s Rav rules that he may rely on the
remains being of a non-Jew and that one may use gentile remains, the shaylah is still not completely resolved. Because Yankel has the bone
graft installed in his mouth, he will now be touching and carrying the remains,
and a cohen may not touch or carry
non-Jewish remains. Is there any possible solution to this issue, or must
Yankel opt for a non-human product? The answer to this question lies in a
different direction.

IS THERE A MINIMUM AMOUNT OF
REMAINS THAT CONVEYS TUMAH?

Here the issue is, how small an amount still conveys tumah? Although the amount of flesh that conveys tumah is one k’zayis, the
amount of human bone that conveys tumah in this situation may be as
small as a k’se’orah, the size of a barleycorn, which is tiny (Ohalos
2:7; Rambam, Tumas Meis 4:4).

How big is a k’zayis?
The estimates of the poskim range from
as little as 3 cc. to as much as 25 cc. A dentist typically uses less than this
amount in a patient, although sometimes he might use a larger amount. Thus, one
should verify this information in order to ask a shaylah. However the
amount of bone used is certainly greater than the size of a barleycorn, thus
precluding a cohen from receiving a dental implant of human origin.

There is one other aspect about dental offices that one
should know: Some dentists keep a human skull on hand for explanation and
education. A cohen should clarify in advance before visiting a dentist whether
he is a skull-bearer, and should make similar research before scheduling an
appointment at the podiatrist and other physicians, who often also use human
remains in their surgeries or have cadaver models on hand for visual explanations.
A concerned practitioner will procure plastic replicas rather than genuine
human parts to mini miz e difficult
situations for a cohen.

A cohen has the
privilege of blessing the people, in addition to serving in the Beis HaMikdash, may it be built speedily
in our day. Concurrent with these privileges come many responsibilities,
including the requirement of avoiding tumah.
This necessitates an awareness of possible tumah
situations and being constantly aware of new developments in our rapidly
changing society.

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